Pulmonary Embolism and Stanford Type B Aortic Dissection in the Same Patient

An 86-year-old female with a history of hypertension for more than 40 years was admitted to our hospital complaining of sudden chest pain 12 hours ago. Physical examination showed no abnormality but mild swellingof the right lower extremity. However, contrast-enhanced Computed Tomography Angiogram (CTA) demonstrated a Stanford type B Aortic Dissection (AD), bilateral pleural effusion, and Pulmonary Embolism (PE) in the left lower pulmonary artery, right pulmonary artery trunk (Figure 1). Meanwhile, Colored-Doppler Ultrasound confirmed the Deep Vein Thrombosis (DVT) in the right popliteal vein.

The patient underwent insertion of an inferior vena cava filter for prevention of further PE. At the same time, conservative therapy was taken for the type B AD. However, she still complained about aggravated chest pain, so another CTA was arranged which showed increased pleural effusion 5 days later

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Therefore Thoracic Endovascular Aortic Repair (TEVAR) was performed and a 36 mm × 36 mm × 200 mm stent-graft was implanted. The result was satisfying and the patient had a smooth recovery with no major adverse events.PE and Stanford type B AD causing chest pain in the same patient is rare with limited cases reported. CTA scanning is a valuable clinical tool for diagnosis.